Steve Kagen seeks health reform; Appleton lawmaker proposes uniform insurance coverage
10 03 08 - 12:06
By Ellyn Ferguson
Post-Crescent Washington bureau
WASHINGTON - Rita Gould never considered herself a medical risk, despite her diabetes. She had never missed a day of work or been hospitalized because of it.
But an insurance carrier said it was a pre-existing medical condition serious enough to deny her the individual health policy she needed to cover a six-month gap between the end of her husband's group health insurance and the start of her Medicare coverage.
She finally got coverage through Connecticut's health insurance pool for people whose pre-existing conditions make them uninsurable. Gould said the premiums cost her $1,300 a month - more than twice what she had paid to continue her husband's group health insurance after he retired.
"It's not fair to have health insurance companies only insure healthy people," said Gould of Killingworth, Conn.
Some in Congress agree with her.
Rep. Steve Kagen, D-Appleton, has introduced a far-reaching proposal that would ban the use of pre-existing conditions for group and individual health policies.
Health insurance, Kagen said, has "evolved to cherry-picking to select the healthiest customer possible and to discriminate or exclude others who aren't healthy."
"No insurance company should be allowed to discriminate against any citizen due to pre-existing medical conditions," he said.
His legislation calls for uniform pricing for health policies that provide the same scope of coverage, allowing for regional differences in costs and risks. His goal is to make it easier for people to comparison shop and to increase competition among companies.
Kagen is among several lawmakers in the House and the Senate with bills to eliminate or modify the use of pre-existing medical conditions as reasons for insurers to deny coverage or charge higher premiums.
"One of every three people in this country has at least one chronic, debilitating or life-threatening issue," said Nancy Davenport-Ennis, president of the National Patient Advocate Foundation. "For most of the plans in this country, having a chronic condition can immediately put you into the pre-existing category if you're trying to get health insurance."
She called Kagen's bill, the latest to deal with pre-existing conditions, "a very robust proposal."
"We are certainly pleased that there is yet another member of Congress who is saying this is an issue and it needs to be addressed," Davenport-Ennis said.
Insurance companies say they would take big financial hits if they could not screen applicants. Some people would only buy health insurance after they have been diagnosed with a costly disease.
An industry trade association, America's Health Insurance Plans, is pushing its own answer to pre-existing conditions. Spokesman Mohit Ghose said that under the proposal, states would create and finance "guaranteed access plans" for people with the costliest medical conditions.
Health insurance companies would provide policies to people who do not qualify for the state plans. Premiums would be higher but capped at a certain level.
"For the first time, the health insurance plans will stand behind any high-risk pool, will act as a backstop to make sure no one falls through the cracks," Ghose said.
Rep. Joe Courtney, D-Conn., said he is trying to find a balance between people's need for health care and insurance companies' financial concerns.
Courtney said it's fine to factor in people's health for something optional like life insurance, but health insurance is different.
"Everyone should have it," he said.
Courtney's bill would shorten the period that insurance companies are able to exclude coverage for pre-existing conditions to people with employer-sponsored health plans. Companies can now restrict coverage for 12 to 18 months under the Health Insurance Portability and Accountability Act (HIPAA).
Courtney would shorten the maximum period for such restrictions to three months. His bill also would shorten the period during which insurance companies can "look back" at people's medical records from six months to 30 days.
The new rules would apply to people in employer group health plans or with individual health policies.
Cheryl Fish-Parcham, deputy health director at Families USA, said past congressional efforts "have chipped away" at the use of pre-existing conditions to limit coverage.
But it still remains an obstacle to health insurance.
"(Some) people can be excluded forever because of a pre-existing condition," she said.